Voluntary medical male circumcision (VMMC) for HIV prevention was highlighted in three presentations and 32 posters at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam from 23 to 27 July 2018. For a schedule of the VMMC presentations and links to summaries of the abstracts, click here.
News & Events
Two million men and boys have been circumcised in Zambia since the government’s voluntary medical male circumcision (VMMC) programme began in 2007, the Lusaka Times reports. In a speech read at the 3 August launch of a national VMMC campaign, a Ministry of Health official said that the 170,000 VMMCs performed this year as of 30 June represent 44 percent of the goal of 400,000 for 2018. He added that the VMMCs performed in Zambia so far have prevented about 17,000 new HIV infections; by meeting its goals for VMMC, the programme can avert an estimated 225,000 new HIV infections by 2030 (Lusaka Times, 3 August 2018).
Voluntary medical male circumcision (VMMC) was identified as one of four HIV interventions that are cost-effective in the most locations in a study of resource allocation among 13 interventions in 52 countries. The study, which was presented at the 22nd International AIDS Conference in Amsterdam on 25 July 2018, aimed to determine how current funds for HIV can best be used. Members of an expert panel at the conference warned that failure to fill a $6 billion funding gap in the global response to HIV threatens to halt years of progress made against the epidemic (Medpage Today, 25 July 2018).
An increase in voluntary medical male circumcisions (VMMC) is among the signs of significant, but insufficient, progress against HIV cited by South African researchers in a Health24 article on 18 July 2018. The South African National HIV Incidence, Prevalence, Behaviour and Communication Survey of 2017 found that the number of men who are medically circumcised rose from 18.6 percent in 2012 to 30.8 percent in 2017. The rate of new HIV infections declined, but it remains high, particularly among young women, who are at three times higher risk than their male peers. The researchers pointed to the need to increase uptake of VMMC and antiretroviral treatment, and South Africa’s health minister called for the introduction of sexual and reproductive health in schools. The survey results were also reported at the 22nd International AIDS Conference in Amsterdam on July 2018 (Health24, 18 July 2018).
More than 1 million men have been circumcised in Zimbabwe since the voluntary medical male circumcision (VMMC) programme began in 2009, ZimEye reports. The country missed reaching its goal of 1.3 million VMMCs by 2015 but is nearing that target now. According to the Ministry of Health and Child Care, more than 1.1 million men have become circumcised, including 301,355 clients who sought and received VMMC services in 2017 alone. The director of the ministry’s AIDS and TV Unit said that after the programme reaches 1.3 million clients, it will continue to provide VMMC services because that will help reduce new HIV infections (ZimEye, 11 June 2018).
A well-known actor’s circumcision kicked off the “Millionth Man Campaign” in ZwaZulu Natal, South Africa, City Press reports. Actor Melusi Yeni said he was happy to join the campaign to help reduce new HIV infections and described his circumcision as “hassle-free.” Having already circumcised 1 million men and boys, the provincial Department of Health (DOH) aims to provide voluntary medical male circumcision (VMMC) services to another million clients. The article includes a link to a web tool that enables parents and initiates to check whether a traditional surgeon is registered with the provincial DOH and to report unregistered surgeons and illegal initiation schools, as well as initiates who are in trouble (City Press, 1 June 2018).
Adolescent girls play an important role in influencing adolescent boys’ decisions about getting circumcised, new research suggests. An article on the HIV website Avert summarises the findings of a study among 90 adolescent girls living near health facilities offering voluntary medical male circumcision (VMMC) and 90 adolescent boys who had been circumcised in South Africa, Tanzania, and Zimbabwe. The study, which was published in a special supplement to the journal Clinical Infectious Diseases, found that the girls preferred their male partners to be circumcised for a number of reasons, including VMMC’s protective effect against HIV and a belief that having a circumcised penis makes a man more attractive. The adolescent boys suggested that encouragement from girls with whom they were romantically involved was one of the factors that motivated them to become circumcised. The results of this small, qualitative study may not apply beyond the participants, but they suggest that VMMC programmes should consider the influence of adolescent girls on adolescent boys’ decisions about VMMC (Avert, 17 April 2018).
New HIV infections among adults in Kenya’s Siaya County have dropped by half since 2011, The Standard reports. An analysis of data from repeated household surveys involving 30,000 people in the subcounty of Gem, published in The Lancet, shows that new HIV infections declined from 11.1 per 1,000 person-years in 2011-12 to 5.7 per 1,000 years in 2012-16. The percentage of 15- to 34-year-olds living with HIV also fell by one-third. These declines occurred at a time when ART coverage among HIV-positive Kenyans increased from 7 percent to 57 percent and male circumcision prevalence in western Kenya, where Siaya is located, rose from 45 percent to 72 percent. In a commentary in The Lancet, Nelson K. Serwankambo of Makerere University writes that “although the declines did not reach the estimated threshold for HIV elimination of one case 1,000 person-years, the findings indicate positive progress and that elimination is possible” (The Standard, 11 April 2018).
Better counselling of younger clients is needed to ensure continued progress in reducing new HIV infections through voluntary medical male circumcision (VMMC), Healio reports. Researchers from Johns Hopkins University surveyed 33 providers and 12 facility managers at 12 VMMC sites in South Africa, Tanzania, and Zimbabwe from June 2015 to September 2016 to identify successes as well as areas for improvement. The study, which was published in a special supplement to the journal Clinical Infectious Diseases, found that older adolescents were more likely to receive HIV prevention counselling and sex education as part of VMMC services compared to younger clients. It also revealed that providers and counsellors lacked training in how to provide such information to boys and young men. The article quotes researcher Lynn van Lith as saying that despite success in “providing a positive circumcision experience, there is more we can do to set these young men on a path toward a healthy life free of HIV” (Healio, 6 April 2018).
The rate of new HIV infections has been reduced by 58 percent since 2011 in Uganda’s Rakai District, dropping from 3.97 per 100 person-years to 1.61 per 100 person-years, Aidsmap reports. Presenting at the Conference on Retroviruses and Opportunistic Infections (CROI 2018) on 6 March, investigator Joseph Kayaagi said that this reduction in HIV incidence came after large increases in antiretroviral treatment, viral suppression, and male circumcision. The data presented are from the Rakai Community Cohort Study, which involves annual surveys in 30 communities. The study results from 2011 to 2016 have been published; this presentation adds data from 2017. The investigators noted that their findings are among the first to show that combination HIV prevention can successfully reduce HIV incidence in a hyperendemic community (Aidsmap, March 2018).
Research on the safety and acceptability of voluntary medical male circumcision (VMMC) was presented in a poster session at the Conference on Retroviruses and Opportunistic Infections (CROI) on Tuesday, 6 March 2018. For links to the abstracts and posters from the session, click here.
A state-of-the-art mobile clinic is enabling Namibia’s Ministry of Health to bring male circumcision to men’s doorsteps, The Namibian reports. The only truck of its kind in the country, the mobile clinic has a fully equipped theatre devoted to performing voluntary medical male circumcision (VMMC) for HIV prevention. It was first dispatched to the Erongo and Ohangwena regions because they have large rural populations. The mobile clinic will remain in those regions until September, when it will be sent to other rural areas to improve access to VMMC (The Namibian, 18 January 2018).
KwaZulu-Natal’s top health official, Sibongiseni Dhlomo, committed to circumcising 1 million men in the province by April, The Citizen reports. He spoke at the homecoming centre for initiates who had been circumcised in Harry Gwala District. The Department of Health forged a partnership with the district’s traditional committee after realising that most male circumcisions were occurring as part of the initiation process for young men. The department works through EG Usher Memorial Hospital, which provides male nurses, health services such as HIV counselling and testing for the initiates, and sterilised surgical equipment, as well as medical observation of the initiates throughout the process (The Citizen, 10 January 2018).
Nearly 5 million men and boys were medically circumcised by programmes supported by the US Centers for Disease Control and Prevention (CDC) in 12 countries in southern and eastern Africa from 2013 to 2016, according to an article published in the 1 December issue of the Morbidity and Mortality Weekly Report. The annual number of voluntary medical male circumcisions (VMMCs) performed by these programmes increased from 2013 to 2015 but declined by 13 percent in 2016 compared to 2015. Almost nine in 10 of the VMMC clients opted to get tested for HIV, with the percentage testing positive in each country ranging from 0.1 to 4.4 percent, and more than seven in 10 returned for a follow-up assessment within 14 days after the procedure (MMWR, 1 December 2017)
Increased uptake of voluntary medical male circumcision (VMMC) and other HIV prevention measures was one of the benefits of an HIV self-testing initiative now being expanded to South Africa, Swaziland, and Lesotho, IOL News reports. In South Africa, more than 2 million test kits will be distributed to improve access to HIV testing and increase the percentage of people who are aware of their HIV status. In Malawi, Zambia, and Zimbabwe, this initiative demonstrated that first-time testers, young people, and more men could be reached with self-testing, and 60 to 90 percent of people in rural areas took up the offer to self-test. Many who tested positive were successfully referred for treatment, and men who tested negative were more likely to use HIV prevention services, such as VMMC (IOL News, 27 September 2017).